Sialorrhea, commonly known as excessive drooling, or hypersalivation, is the inability to control oral secretions resulting in excessive accumulation and involuntary loss of saliva from the mouth. In a normal healthy individual, there is a balance between the production of saliva in the mouth by the salivary glands and the swallowing reflex which eliminates pooling of saliva from the oropharynx. When this balance is perturbed by increased saliva production and/or decreased swallowing reflex, it leads to the pooling of saliva in the mouth and consequent involuntary loss.
Sialorrhea is one of the major non-motor complaints in patients suffering from various neurological impairments, including Parkinson's disease, cerebral palsy, Amyotropic Lateral Sclerosis, Huntington's disease, stroke and traumatic brain injury. Sialorrhea is also a commonly occurring side effect of certain antipsychotic medications such as clozapine.
Sialorrhea leads to a range of physical and psychosocial complications including perioral chapping, dehydration, odor and social embarrassment and isolation. Sialorrhea is often described by these patients as one of the most significant disabling social problems of their disease. Depending on its severity, drooling can result in medical disability, impaired speech or serious eating difficulties.
Anticholinergic drugs, which are well known to produce “dry mouth” by reducing salivary flow have been used to treat patients suffering from sialorrhea. Recently the FDA approved a treatment of sialorrhea using glycopyrrolate in pediatric patients aged 3 to 16 years with neurologic conditions associated with problem drooling (e.g. cerebral palsy). It is available as 1 mg/5 ml oral solution. It has to be taken three times a day, one hour before or two hours after meals. The dose has to be carefully titrated for each patient from a low starting dose in increments of 0.02 mg/kg every 5-7 days.